Healthcare Provider Details

I. General information

NPI: 1790075513
Provider Name (Legal Business Name): MRS. VELMA R PEARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5781 STONE VALLEY DR
STONE MOUNTAIN GA
30087-1840
US

IV. Provider business mailing address

2740 SHOEMAKER LN
SNELLVILLE GA
30039-8097
US

V. Phone/Fax

Practice location:
  • Phone: 404-935-9438
  • Fax: 404-935-9438
Mailing address:
  • Phone: 404-287-4572
  • Fax: 678-395-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: